| NPI | 1205868726 |
|---|---|
| Former Name | AMY LYNN WALLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9106130) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA01022) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA01022) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-01-11 |